Common Conditions

Painful Intercourse for Women (Dyspareunia)

Feb 11, 2015

Sex is supposed to be enjoyable, not painful. But many women have pain during intercourse. The medical term is “dyspareunia.” The American Congress of Obstetricians and Gynecologists estimates that 3 in 4 women experience it at some point.

The pain might occur at the start of penetration. Or, it could happen with deep penetration and thrusting. It can start suddenly or be a lifelong situation. It may be a dull ache or a sharp pain. Some women feel pain in their vulvar region – the area surrounding the vagina. Others have pain in the vagina itself or in the pelvis or lower back.

There are many reasons, both physical and psychological, that a woman might feel pain during intercourse. Today, we’ll discuss some of them and offer some strategies for coping.

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Physical Factors

Here are some of the more common physical factors that can cause sexual pain in women:

· Hormonal changes. When women go through menopause, their estrogen levels drop significantly. This can lead to vulvar and vaginal atrophy. The vagina becomes less moist and flexible. Estrogen is also important for vaginal lubrication. If the vagina isn’t lubricated enough, the friction from penetration can be uncomfortable. Hormonal changes don’t just occur during menopause, though. Breastfeeding women have lower levels of estrogen, too, and can experience vaginal dryness because of it.

· Recent childbirth. The vagina needs time to heal after childbirth. If a woman’s vagina was cut to ease delivery, she may still be sore for a while. Many obstetricians recommend waiting six weeks before having vaginal sex again.

· Medications. Some drugs can interfere with arousal and lubrication. Examples include antidepressants, blood pressure drugs, and birth control pills.

· Inflammation and infections. Certain infections, like urinary tract infections, yeast infections, and vaginitis make sex painful. Skin conditions like eczema and dermatitis can as well. Skin can also become irritated by douches, perfumed soaps, and other personal products.

· Gynecological conditions. There are many conditions that can cause sexual pain:

o Uterine fibroids – tumors that form inside or outside the uterus or within the uterine wall

· Vaginismus. Women with vaginismus experience involuntary spasms of vaginal muscles at the start of penetration. They can’t control these spasms. Sometimes, the vagina almost closes, making penetration next to impossible.

· Other medical conditions and treatment. Some women with arthritis, thyroid conditions, and diabetes have pain during sex. Cancer and its treatment, including pelvic surgery, can cause problems, too.

· Female genital cutting. In some cultures, particularly in parts of Africa and the Middle East, girls’ genitals are cut or removed. Vaginas may be stitched so that they are almost closed. These practices can lead to sexual pain as well as serious infections and hemorrhaging.

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Emotional and Psychological Factors

For women, sex and emotions are closely bound. If something is troubling you, it could be affecting your ability to relax. If you can’t relax, your pelvic floor muscles can become tense and it’s more difficult to become aroused. Both of these issues contribute to sexual pain.

· Anxiety. You may feel anxiety in general or anxiety about sex in particular. Some women believe that they are not supposed to enjoy sex and feel shame if they do. If you don’t have much sexual experience, you may become anxious about expected pain or worry about your partner’s pleasure.

· Stress. It’s hard to relax with your partner if you’re worried about a to-do list that’s too long or you’re having a rough time at work. You might also be exhausted from childcare or helping elderly parents.

· Body image. Some women are concerned that their naked body will turn off their partner. This is common in women who have had surgery.

· Problems in your relationship. If you’re upset with your partner, you might not feel much desire for sex and become less aroused.

· Past sexual abuse. Your body may “remember” the pain of this abuse and anticipate it, even if you are in a stable, loving relationship now.

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What Should You Do?

First, see your gynecologist. If a serious condition is causing the pain, such as endometriosis, pelvic inflammatory disease, or ovarian cysts, it’s important to treat that. Women with vaginismus may benefit from physical therapy and sex therapy. A doctor can also help you decide if you need to change a medication because of sexual side effects.

If you’re past menopause and your estrogen levels have declined, your doctor might recommend a lubricant or hormone therapy to help with poor vaginal lubrication. A drug calledospemifene (Osphena) may also help.

If the problem stems from psychological or emotional troubles, your doctor might refer you to a counselor or sex therapist. You may consider asking your partner to go with you, but it’s okay to go alone.

A sex therapist can help you and your partner better understand and communicate each other’s feelings and needs. If you have a history of sexual abuse or feelings that make you uncomfortable with sex, a counselor can help you work through those issues, too.

Be sure to talk to your partner as well. He or she might not realize that you have pain during sex. You might try different positions to see if you can find one more comfortable for you. Or, you could try having more foreplay to make you fully aroused. Keep in mind that sexual activities that don’t cause pain, such as oral sex and mutual masturbation, can be just as pleasurable for both of you.

Some women feel uncomfortable about discussing sex with a doctor or a partner. They might feel that women aren’t supposed care so much about sex. It can be a difficult subject to bring up. But it’s worth it. Your doctor will understand your concerns. He or she has probably treated many women just like you. And your partner will likely be glad you spoke up.